Computed tomography of herpes simplex encephalitis, with clinicopathological correlation

Area of Science:

• Neurology
• Radiology
• Infectious Diseases

Background:

• Herpes simplex encephalitis (HSE) is a severe neurological condition.
• Accurate and timely diagnosis is crucial for patient outcomes.

Purpose of the Study:

• To review computed tomographic (CT) findings in biopsy-proven herpes simplex encephalitis (HSE).
• To correlate CT findings with clinical and pathological data.
• To assess the diagnostic utility of CT in HSE.

Main Methods:

• Retrospective review of clinical, pathological, and computed tomographic (CT) findings.
• Analysis of 17 CT scans (5 plain, 12 contrast-enhanced) from 9 patients with biopsy-proven HSE.
• Evaluation of CT abnormalities, including low-absorption areas, mass effect, and contrast enhancement patterns.

Main Results:

• Low-absorption abnormalities were the major CT finding, present in 64% of scans, primarily affecting the temporal lobes.
• Mass effect was observed in 52% of scans.
• Abnormal contrast enhancement patterns, particularly in the sylvian fissure and opercular areas, were seen in 50% of contrast-enhanced scans.

Conclusions:

• CT findings in HSE are characteristic and can support diagnosis.
• The combination of temporal lobe abnormalities and specific enhancement patterns on CT is indicative of HSE.
• CT plays a vital role in the diagnostic workup of suspected HSE when integrated with clinical presentation.